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Alternate summary: we've given you 140+ pages which are totally and utterly incomprehensible, unless you have a copy of the Internal Revenue Code right in front of you. So there's little danger that you might read this and figure out just what we are really doing. Makes it easier to spin it -- which God knows is going to be necessary.

Where's the surcharge for not maintaining continuous coverage? I don't see it in there. If it's not, this bill would destroy the individual market so either the Rs are totally feckless or they know it is DOA.

The surcharge may not have survived the Senate Parliamentarian and the rules for bills being handled under reconciliation. It appears to me that the surcharge is purely a matter of regulating health insurance and does not touch the budget. That would normally make it off limits for reconciliation.

we've given you 140+ pages which are totally and utterly incomprehensible, unless you have a copy of the Internal Revenue Code right in front of you.

To be fair, I think that's true of a lot of legislation - anything that involves changes to existing laws or policies.

Long ago in a galaxy far far away, I spent probably a couple of hundred hours trying to get my head around the USA Patriot Act. Much of the text of that law consisted of arcane tweaks to existing US Code. It read like instructions for a bizarre treasure hunt game.

Yes, most legislatures write bills in some sort of semi-formal diff format. It was one of the skills I had to master when I was on a state legislative staff. Ordinarily there will be an enrolled version of the sections that are modified that's readable. However, those are usually classed as internal working papers that are not distributed to the public.

Michael Cain, I figured that was the case. It doesn't get around the fact that Senate bill as is would wreck the individual market. I don't know much about Senate procedure. Can the surcharge be added without 60 votes later or is the concept unable to be passed at all in the Senate without D votes?

IIRC, the presiding officer of the Senate can overrule the parliamentarian and be sustained by a simple majority. If that's the route they're going, I can think of tactical reasons that McConnell might prefer to fight that battle over an amendment.

Personally, I think it's time for federal standards of procedure for federal elections. Mandating, among other things, paper ballots.

I'm fine with states making their own rules for state elections. I'm not fine with all of the half-assed slap-dash ways that many states go about handling stuff at the federal level.

Who your governor and state rep are affects you. Who your House rep and Senator are affect me. There are gaping holes in the basic reliability and security of the federal election process that are, to me, plainly unacceptable.

As far as the Senate AHCA bill goes, last time I peeked there were 5 (R) Senators agin it. So, maybe there will be some horse-trading in our future.

We'll see where it all lands.

If you make it really hard for people to just get by in life, it's not likely to end well. For anyone. This is not a mystery.

So, is this bill good for you? Yes, if you meet the following criteria:

1.Your income is more than $200,000 a year
2.You have a job that comes with good health insurance
3.You can’t imagine any circumstances under which you lose that job or income
4.You don’t have any family members or friends who don’t meet those criteria
5.You have zero empathy for anyone else

Or, of course, if your goal in life is to piss off libruls even if it costs you money.

, I think it's time for federal standards of procedure for federal elections. Mandating, among other things, paper ballots.

What we use in California, and have for years, are paper ballots which are electronically scanned at each polling station. The voters feed them into the scanner/repository themselves. At the end of the day, both the thumb drive and the paper ballots get taken off to the county seat to be input to the state totals and archived.

I'm not. Or at least I think there need to be national standards for things like number and distribution of polling places and methods of voting, so voting is no harder for one individual or neighborhood than any other.

I get the feeling that GOP leaders, like their voters, don't know much more about health care issues than what they hear on Fox, and aren't actually aware of what's in this bill and what it does. And that if it passes (which I fear is likely) and then millions of people lose insurance, and thousands of people die, they'll believe it's all just the aftershocks of Obamacare -- because that's what FoxNews will tell them.

One of the smartest things we have done in my lifetime in California was take redistricting out of the hands of the legislature. Gave it to a non-partisan group, which has done a quite good job of creating districts that are
1) balanced in population,
2) roughly follow communities (i.e. not ones where you have to go thru 3 other districts to drive from one part of the district to another), and
3) pay no attention to the desire of politicians to advantage a) themselves personally, and b) their party, in shaping districts.

We still have some districts that would be considered "safe". But that's because of clustering by home location by voters. Not because the district was gerrymandered to make it that way.

"Over the weekend there seems to have been a lot of out-and-out lying on the part of GOP & presidential spokesbeasts, saying that the bill won't gut Medicaid."

No, it in does the taxes, mostly, put in place by the ACA, which by the nature of taxes is better for the rich, always. Some people remember it was specifically touted as a tax on the rich but, nonetheless.

The bill reduces the rate of growth of Medicaid and pushes the responsibility for those people back to the states. That is a fact. "Gutted" is hyperbole. "People will die" is hyperbole.

The assumptions of all these bad outcomes are in direct conflict with russell's confidence that in his state things would be fine.

The CBO, the first time, estimated half the states would not ask for waivers of some kind, 31 states have expanded Medicaid, they would be unlikely to ask for a waiver on preexisting conditions. Oh, and everyone has to have a high risk pool to even apply.

There seems to be a lot of out and out lying but it isn't from the GOP.

In fact, the GOP is actually having a discussion of the best compromise to move this forward.

The GOP (in the Senate) is having a discussion on whether they can find something that will simultaneously satisfy the 4 Senators who want the slashes to be harsher (i.e. roll back more of Obamacare) and the 3-4 Senators who object to the slashes being as deep as they are in the current bill. Whether they can square that circle remains to be seen.

NPR has been pushing back against the GOP's lies. but why should the GOP care? they don't have to please anyone who doesn't already love them.

they'll believe it's all just the aftershocks of Obamacare -- because that's what FoxNews will tell them.

i'm 100% sure that's the plan. any problems? blame Obama. it's already perfectly clear that the GOP base, being full of people who happily voted for the idiotic morally-bankrupt prevaricator, will never bother wondering if it's true.

"hahaha...like voting rights? Look, if you give the states less money, they will find a way to cut coverage. "

I would probably have voted for Kasich. But when you give the states a benefit 100% paid for by the federal government, guess what? They become politically entrenched to retain that because otherwise THEY have to pay for it.

That is a stupid way to fund healthcare and leads to forever rising costs.

BTW, block granting Medicaid is a much better way to achieve optimum value than national single payer. Both have to figure out how to allocate finite resources, but states can do it different based on local circumstance.

Not only will the bill actually kill people, the Social Security savings (dead people get no benefits!) is part of the CBO score for the House bill.

The bill reduces the rate of growth of Medicaid and pushes the responsibility for those people back to the states. That is a fact. "Gutted" is hyperbole.

There will be less money for Medicaid, though it is the sector of American health care where costs are growing slowest. Pushing it back to the states means administrative effort will be duplicated and high-risk pools will be underfunded.

This is going to look like "gutted" to a lot of people whose lives are on the line. Why doesn't it seem that way to you?

block granting Medicaid is a much better way to achieve optimum value than national single payer

That depends on what your definition of "optimum value" is. As Neil Irwin says, the health care bills demonstrate what the political parties really care about:

Democrats are focused on trying to maximize the number of people who have decent health insurance, and are willing to accept whatever tax increases and arrangements with health insurers and other private interests are needed to make that happen. They seek the broadest possible availability of health care, whatever the cost and political trade-offs it takes to achieve it.

Republicans are focused on trying to minimize taxes, especially on investment income, and keeping federal subsidies for health care to a minimum. They are willing to accept the wrenching consequences that attaining those goals might have for Americans’ insurance coverage, betting that lower taxes and smaller government will fuel a more vibrant economy.

Is your "value" controlling costs overall, controlling costs to people who aren't sick yet, or health care for more Americans? The GOP has made its priorities very clear.

I'm just now figuring in the back of an envelope the savings in government pensions that can be achieved if the health conditions of 239 republican reps and 56 republican senators, not to mention an entire White House full of murderers, the entire right wing media crew of jackals and carrion-eaters, the entire right wing citizens united killers, and the entire right wing enclave of academic and think tank sadists take a sudden, simultaneous, and catastrophic turn towards make-shift morgues.

Medicaid spending *totals* have grown because of Medicaid expansion. As far as I can tell, cost per enrollee has grown much, much more slowly than for other parts of the health care system.

If the goal was actually to control overall health care costs, get more people on Medicaid.

Contra your statements, single-payer controls costs much better than other systems. This is because only single-or-very-few-payer systems have bargaining power with drug companies, hospitals, & other providers.

Sadists norquist and company have made the most inroads in state and local jurisdictions, precisely to ready themselves to gut the social safety nets as they are capped to the states responsibilities.

"In some states, the homeless are a significant drain on Medicaid. If through block grants, those states could use Medicaid funds for housing, there could be a net reduction in cost."

The states have been free to house the homeless on their own ticket since the founding, but most refuse to do so.

Utah, I understand, until recently, is an exception. The VA, via its unelected bureaucrats in DC (the ones brave enough to risk having their heads shot off) has done yeoman work managing and finding homes for the homeless veteran population across the country in recent years.

Marty says nobody is going to suffer. Maybe Marty has a rabbit in his hat.

But, but . . . President Trump says he wants a bill that will be better for everybody. One which won't hurt anyone. And he's President, so you have to believe he will get what he wants. After all, his party controls Congress. Right? Right?

Among the reasons that health care costs a lot in the US is that we make few intelligent efforts to control the cost. Cost control here amounts to badgering patients to make sure they really, really, really need whatever it is they think they need, and/or just capping expenditures and leaving it to either providers or patients to figure it out.

Block-granting federal money to the states can make the feds feel all proud of themselves for "doing something" about the cost of care, but it's basically just passing the hot potato off to somebody else.

Some states may be more creative or innovative about how they go about things, and so might come up with better outcomes for a given amount of $$$. Some states have more resources to bring to the table, and so they will also not suffer too much.

But a lot of folks will suffer, because their state governments aren't that clever, or because their state doesn't have the same level of resources to work with.

Folks can "complain to their governors", but they'll still be SOL.

What I think is going to happen is that the (R)'s will figure out some way to get their tax cut, come hell or high water, and whatever has to shift to accommodate is going to by god shift.

If that means there are fewer resources in your state to help people who are hard up, then that's what's going to happen.

If you don't like it, you're going to have to vote yourself a new state legislature, because the (R)'s in DC are washing their hands of you.

If they don't get it done this time around, they'll try and try again. They've wanted this for decades, and this is their best shot. They're gonna get it or die trying.

If we actually want to reduce costs, there are ways to do it. We don't give a crap if we reduce costs or not, we just don't want to pay the bill.

The hot potato will be passed. If not this week, some other time, and sooner rather than later.

Don't think republican vermin wouldn't stage a state of emergency to renege on the debt, cut taxes, and repeal Obamacare.

Fall would be good timing, I'm guessing.

I have a new favorite musician, despite the fact that I have yet to hear a note of his music:

Father John Misty. A quote:

"Do we think our hilarious tyrant is going to be met with a hilarious revolution led by hilarious revolutionaries and the the whole thing is going to be, like, entertaining as fuck the whole time? I always thought that it was going to look way more sophisticated than this when evil happened?"

Me:

People always expect Hitler when no one expects the Spanish Inquisition. Sometimes it's just a passel of glib comedians in cheap suits who come to kill us.

Let's say you have a massive heart attack while playing Twister on the ground plaque straddling the four corners area where state lines for Utah, Colorado, New Mexico, and Arizona intersect.

Which way would you fall? Or more specifically, would a conservative pass out into the state with the cheapest coverage and a liberal pass out into the state with the most coverage?

Still struggling with Russell's question about the difference in being sick from state to state.

I suppose if melanoma was involved it would be an equally serious, expensive and deadly disease for all of one states' citizens, but in another it might be a serious, expensive, and deadly disease for those covered, but a punchline (take my melanoma .. please!) when the undeserving weren't covered.

I don't believe the CBO addressed the money saved by the lack of coverage of dead Americans no longer receiving SS benefits, although I understand Chicago has carved out a special exception for their dead to continue coverage.

this will be a "yeah, but" thing pointed by republicans on next Sunday's talk shows.

"yeah, but, you haven't considered the financial upside on the deficit from savings on the undeserving dead, by which we mean the deserving dead who are enjoying the fruits of freedom in America."

Mitch (potato famine) Mulvaney would point out that the undeserving dead and the living who are living undedervedly are providing a form of charity to the 1% whose taxes have been cut.

To which they ask: "Will I be able to take a charitable deduction for that on my taxes?"

I don't believe the CBO addressed the money saved by the lack of coverage of dead Americans no longer receiving SS benefits, although I understand Chicago has carved out a special exception for their dead to continue coverage.

Now Count, you know this is just plain silly. Obama is from Chicago. So no way it gets any kind of exception whatsoever!

Remember how I was saying that we shouldn't vilify the rich? Well, it depends on which rich.

"According to Forbes’ estimate, Chuck and Dave have a net worth of $96.6 billion. The question that most interests me is why two men whose combined wealth is greater than the annual gross domestic product of two-thirds of the world’s sovereign nations (note: not hyperbole) are so obsessed with protecting and expanding the wealth and power of a national and global plutocracy that has already achieved obscene levels of both.'

And this: "At a weekend event with conservative donors, top aides to Charles Koch, the billionaire energy magnate, said the Senate bill does not go far enough to dismantle former President Barack Obama's signature healthcare law, also known as Obamacare."

It's just ever so much easier to be an extreme libertarian if you are so rich that you never need worry your little head about the government doing something for you. (Of course, you have to turn a blind eye to all the government programs which made your wealth possible in the first place.)

Those numbers, except for being at 350% instead of at 400% are better than it is now. I know I made over 400% last year(mostly at the backend of the year), and paid the difference in a lump sum on my taxes. Luckily I was in a Florida plan at the time.

It's just ever so much easier to be an extreme libertarian if you are so rich that you never need worry your little head about the government doing something for you.

If I had $96.6 billion, maybe I'd be bored with fabulous vacations, yummy food, anything else I wanted, and the only think I could think of left to do, having done it all, and being so bored, would be to stick it to the poor. I hope I wouldn't be doing that. JFC. (Oh, right, they're Christians. WWJD? Would he really be doing that?)

If I had $96.6 billion, maybe I'd be bored with fabulous vacations, yummy food, anything else I wanted, and the only think I could think of left to do, having done it all, and being so bored, would be to stick it to the poor.

I think you're missing the point. They aren't (at least in their minds) "sticking it to the poor." They're just trying to advance an ideology that they devoutly believe in. It happens to be one which is, as I said, far easier to believe if you are filthy rich (or a college student on a full mommy/daddy scholarship).

But there really isn't any malice in it. Just lack of empathy -- or maybe lack of imagination, to realize how the rest of the world lives.

But there really isn't any malice in it. Just lack of empathy -- or maybe lack of imagination, to realize how the rest of the world lives.

Yeah, maybe. I still can't look at people who see the world in this way and feel any sense of kindness towards them. Although, I've been really nice to a lot of A@@holes when the chips were down for them, so I probably would.

That's probably how this crap happens. People who have a moral compass give other people the benefit of "no malice" until they are, themselves, f'd.

Making somebody else pay doesn't make the cost go down. Handing the hot potato from the feds to the states doesn't make the costs go down. Handing the hot potato from the states to patients doesn't make the costs go down.

The reasons why health care costs a lot in this country don't have all that much to do with who pays.

If you think some guy in Pierre SD, or Jefferson City MO, or Boston freaking MA for that matter, has a better understanding of how to deal with and pay for public health than some guy in DC, I suspect you are in for a surprise.

Diabetes and Alzheimers and cancer and god knows what are not that much different in SD and FL and MA.

What a fucking mess. Just the cost of having the whole freaking insurance industry stop on a dime and make a new plan every time the majority in Congress changes probably costs us more than everything we spend on Medicaid.

We may be the stupidest country on earth. OK, North Korea is stupider, we're second.

I understand perfectly russell, but to be clear, the difference is most of what the cost is. Below 350% you get subsidies and discounted plans. If you pick the full subsidy, meaning if you are sure you won't make more, you pay about 3k or less for a Silver plan.

But the difference is now you get all that uptick at 350% rather than 400% but the uptick is a little smaller, it seems from my memory. Maybe because the initial subsidy is a little less, not sure.

But thats being presented like its new. I call bs. It's not a huge change.

And btw, the reason I think it's less is my difference in Fl in 2016 was 5k, but I only took half the subsidy because I was afraid I would end up with too much income for the full subsidy. A contract in Dec put me over 400% and I owed it all.

Under 138% you don't get subsidy, you get Meficaid,or if you are in a no expansion state you get to have NO insurance with no penalty.

Thats a problem I can get worked up about. They all lie, or everyone would be covered.

The CBO says that poor people won't buy plans because they have deductibles that are too big, you mean 6-12k? Like right now?

I'll entertain the 22 million number when they score the ACA. Because nothing they say will cause the increase in uninsured is not applicable to what we have now. Except Medicaid won't grow out of control.

"What a fucking mess. Just the cost of having the whole freaking insurance industry stop on a dime and make a new plan every time the majority in Congress changes probably costs us more than everything we spend on Medicaid."

It's like when Americans decide to provide the world with free trade and spend years negotiating treaties to provide such, and then, on a turn of a dime because of bullshit whims, decide we don't like the arrangement.

Never trust a pigfucking American, never shake hands on a deal with a pigfucking American, never turn your back on a pigfucking American, NEVER keep the safety on in the presence of a pigfucking American, because pigfucking Americans are thinking at all times how to fuck the guy they signed the deal with.

Even for those of us inured to the effects of right-wing propaganda, it is bizarre to watch a party attempt to carry out a major welfare-state rollback while fervently insisting the welfare state will not be rolled back a single inch.

not so bizarre.

this is, after all, the party of Family Values who made itself into the party of the Lying Bankrupt Adulterer in the span of about two months.